Provider Demographics
NPI:1275580060
Name:TAYLOR, RODNEY J (MD)
Entity Type:Individual
Prefix:
First Name:RODNEY
Middle Name:J
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:VA MEDICAL CTR
Mailing Address - Street 2:215 NORTH MAIN STREET
Mailing Address - City:WHITE RIVER JUNCTION
Mailing Address - State:VT
Mailing Address - Zip Code:05009-0001
Mailing Address - Country:US
Mailing Address - Phone:802-295-9363
Mailing Address - Fax:802-291-6262
Practice Address - Street 1:VA MEDICAL CTR
Practice Address - Street 2:215 NORTH MAIN STREET
Practice Address - City:WHITE RIVER JUNCTION
Practice Address - State:VT
Practice Address - Zip Code:05009-0001
Practice Address - Country:US
Practice Address - Phone:802-295-9363
Practice Address - Fax:802-291-6262
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2012-06-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA226815208800000X
NH15141208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2111578Medicaid
VT1014570Medicaid
NH32001366Medicaid
MA2111578Medicaid
MAA39533Medicare PIN